Provider Demographics
NPI:1447799796
Name:WEST VALLEY OTC LLC
Entity Type:Organization
Organization Name:WEST VALLEY OTC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-935-9920
Mailing Address - Street 1:12409 W INDIAN SCHOOL RD STE B210
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9505
Mailing Address - Country:US
Mailing Address - Phone:623-935-9920
Mailing Address - Fax:
Practice Address - Street 1:12409 W INDIAN SCHOOL RD STE B210
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9505
Practice Address - Country:US
Practice Address - Phone:623-935-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty